(CS-037) Using Wound Care as Adjunct Management in a Difficult-to-Reduce Large Gastroschisis: A Case Study

Astrid Leon Silva, MD – Neonatal Fellow, Neonatology, UM/JMH

Introduction: Gastroschisis is a paraumbilical congenital abdominal wall defect in which intestinal viscera herniates usually from a small defect to the right of the umbilicus. There are some cases of large Gastroschisis; these present closure challenges. This condition is usually managed by primary closure or a prosthetic silo placement, followed by a staged gradual reduction and skin closure by a Pediatric Surgeon. In this case study, a new innovative wound care regimen using Hydrofera Blue Ready*, Stimulen * powder, and Xeroform gauze* was used as adjunct management in the reduction and healing by secondary intention after BioMesh grafting.

Methods:

The patient is a 36 3/7 week gestation late premature infant born with a large gastroschisis. At birth patient’s intestines were placed in a silo bag and incrementally reduced to the abdomen by nine days of life. Visceral evisceration occurs three days post repair requiring a second reduction. The hospital course was complicated by respiratory failure, anasarca, and acute kidney injury. At 20 days of life, the patient underwent gastroschisis repair with a BioMesh placement and partial skin closure. The reduction site was managed by pediatric surgery using daily betadine gauze for one month, but granulation of BioMesh to skin failed to occur. A wound care regimen utilizing Stimulen * powder x 7 weeks; Hydrofera Blue Ready* dressing x 11 weeks and later Xeroform * x 2 weeks was used as an adjunct to the BioMesh to reduce and heal the defect. Wound care was provided every 3-5 days.

Results:

One month after BioMesh grafting, reduction and closure through secondary intention were stalled. The wound care regimen described above was a successful adjunct in the reduction and closure of this large gastroschisis by secondary intention four months after installation.

Discussion:

Large gastroschisis may be closed using prosthetic material, for example, surgisis *, gore-tex*, silastic silo *, and autologous materials – umbilical cord, dura, musculocutaneous flaps, and meshed skin grafts. This case study showed that a wound care regimen can be a good adjunct and sometimes essential in these cases.

Trademarked Items: Stimulen Powder
Hydrofera Blue Ready
Xeroform Gauze
Surgisis mesh
Gore-Tex mesh
Silastic Silo bag

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